Ch 4 Perio Dz 1 Flashcards
What is the term for gingivitis that has a prevalence between 9 and 14 years of age?
puberty gingivitis
What are the ages seen in bimodal gingivitis?
puberty then returns to 100% prevalence in the 6th decade of life
In general which sex has more gingivitis?
In general men have more ginigivits, but women can have more during times of high progesterone (pregnancy or oral contraceptives)
Where does the unique pattern of gingivitis appear for mouth breathers?
anterior facial ginigiva (smooth swollen red)
What is the type of gingivitis that is idiopathic, but possibly caused by an isolated patch of exteriorized junctional or sulcular epithelium that may be altered secondarily by local factors, such as mouth breathing?
First described in 2007…
What is the alternate term?
Localized Juvenile Spongiotic Gingival Hyperplasia
Alternate: Localized Juvenile Spongiotic Gingivitis (LJSG)
What helps rule out puberty gingivitis when suspecting localized juvenile spongiotic gingivitis?
puberty gingivitis responds to improved oral hygiene, LJSG does not (also puberty gingivitis will have estrogen and progesterone receptors present)
Whats the median age for LJSGH? Gender? Location?
12 years…female..maxillary anterior facial gingiva
What stain is positive in localized juvenile spongiotic gingivitis? What other tissue type is positive for this?
CK19, sulcular epithelium is also CK19 positive while the facial gingiva is not
What is the recurrence rate range for localized juvenile spongiotic gingivial hyperplasia?
6-16.7% with excision (why dont they mention corticosterioid therapy?)
What are the two alternate names for necrotizing ulcerative gingivitis?
- Vincent Infection (French physician who first described it)
- Trench mouth (WW1)
What are the 5 bacteria associated with necrotizing ulcerative gingivitis?
What are the 3 viri possibly associated with NUG?
What is the primary exogenous cause?
Bacteria
- Fusobacterium nucleatum
- Prevotella intermedia
- Porphyromonas gingivalis
- Teponema spp
- Selenomonas spp
Viri
- CMV
- EBV
- HSV
Psychologic stress (immunosuppression, smoking, local trauma, poor nutritional status, poor oral hygeine, inadequate sleep, recent illness)
What two immunosuppressed conditions are associated with NUG?
AIDS and Mononucleosis
What condition can clinically mimic NUG?
agranulocytosis (lack of granulocytes)
caused by medication
NUG: typical age
young, middle aged adults
If NUG is suspected based on clinical appearance, BUT there is no putrid smell….consider this:
gonorrhea!
What is the term for NUG that spreads to the other tissues? What about if it spreads to the skin of the face?
necrotizing ulcerative mucositis (NUM) or necrotizing stomatitis….to the face: noma (cancrum oris)
NUG treatment?
remove the bacterial challenge
- conservative debridement/scaling, currettage, utrasonic (CONTRAINDICATED in HIV pts? no evidence)
- rinses (chlorhex, salt water, diluted H2O2)
- Abx (metronidazole, penicillin)
Alternate name for plasma cell gingivitis?
atypical gingivostomatitis
What was the first cause of plasma cell gingivitis in the 1960s/70s?
hypersensitvity to a component of chewing gum
The cause of more current cases of plasma cell gingivitis is still an allergin - what are three examples?
- herbal toothpaste
- mint candy
- peppers for cooking
Histologically, what two conditions can be identical to plasma cell ginigivitis (allergen/idiopathic) and how are these ruled out clinically?
- Plaque-related gingival hyperplasia (non-rapid onset, improves with better oral hygeine)
- chronic periodontitis (non-rapid onset, improves with better oral hygeine)
Treatments for plasma cell gingivitis?
- diary - track and remove possible allergens
- allergy testing
- topical or systemic immunosuppresive medications
Graulomatous ginigivitis is non-necrotizing granulomatous inflammation and is a subset of which condition? What % of patients with this condition have granulomatous gingivitis?
orofacial granulomatosis
25%
What two things should be ruled out when seing non-nectotizing granulomatous inflammation in the gingiva?
- foreign body
2. infection (fungal, mycobacterial)
What can granulomatous or foreign body gingivitis mimic clinically?
gingival lichen planus
Patients who do not respond to surgical removal
and have recurrences of granulomatous gingivitis despite cautious dental care probably should be classified as having _________ and managed accordingly.
orofacial granulomatosis
What are the 8 entities on the differential diagnosis for desquamative gingivitis?
- mucous membrane pemphigoid
- Erosive lichen planus
- Pemphigus vulgaris
- Linear IgA disease
- Epidermolysis bullosa aquisita (EBA)
- Systemic lupus erythematosus (SLE)
- Chronic ulcerative stomatits (CUS -SLE in just the mouth, tx w hydroxychloroquine)
- Paraneoplastic pemphigus
Of all the medications associated with drug-related gingival hyperplasia (thank you Dr. Paul Freedman) - which 3 are the ONLY ones with a “STRONG” association?
- Nifedipine (25% of patients treated w the drug show hyperplasia)
- phenytoin (50% of pts)
- cyclosporine (25% of pts)
What two drugs are sometimes used in conjunction, thus creating drug-related gingival hyperplasia?
cyclosporine causing HTN, then using nifedipine
What are the 6 types of gingivitis?
- Plaque-related gingivitis
- Necrotizing ulcerative gingivitis
- Medication-influenced gingivitis
- Allergic gingivitis
- Specific infection-related gingivitis
- Dermatosis-related gingivitis
What are some systemic factors associated with gingivitis?
- hormonal changes (pooberty, pregers, contraceptives)
- stress
- substance abuse
- poor nutrition (vit c def)
- medications (phenytoin, nifedipine, cyclosporine)
- DM
- Down syn
- immune dys
- heavy metal poisoning
What are some local factors associated with gingivitis?
- local trauma
- tooth crowding
- dental anomalies (enamel pearls)
- tooth fracture
- dental caries
- gingival recession
- high frenum attachments
- iatrogenic (restorations, prosth, ortho)
- inadequate lip closure
- mouth breathing
Which drug that causes gingival hyperplasia is least likely to resolve the hyperplasia with improved oral hygeine?
cyclosporine
What is an associated risk factor for drug induced gingival hyperplasia?
smoking
How long does it take for the drug-induced gingival hyperplasia to start after starting the med?
1-3 months
What systemic or topical treatment has been found to help with drug-induced gingival hyperplasia? What antibiotic?
folic acid (vitamin B9)…metronodazole (azithro and roxithro too)
What are the 2 alternate names for gingival fibrosis?
- Fibromatosis gingivae
2. Elephantiasis gingivae
Prevalence of gingival fibromatosis? Typical age? Which arch affected more often?
1:750,000…young - before age of 20…maxilla (palatal)
What are the 8 possible ‘other findings’ in a patient with gingival fibromatosis?
- hypertrichosis (unforgettable photo in neville lol)
- generalized aggressive periodontitis
- epilepsy
- intellectual disability
- sensorneural deafness
- hypothyroidism
- chondrodystrophia
- growth hormone deficiency
What are the 9 syndromes associated with gingival fibromatosis?
- Byars-Jurkiewicz Syndrome (hypertrichosis, gingival hypertrophy, giant fibroadenomas of breast, and kyphosis)
- Costello syndrome (delayed development, intellectual disability, loose folds of skin (esp hands and feet), unusually flexible joints, large mouth with full lips. arrhythmia, structural heart defects, hypertrophic cardiomyopathy, short stature, tight Achilles tendons, hypotonia), Chiari I malformation, skeletal abnormalities, dental problems, and problems with vision)
- Cross syndrome (Hypopigmenation/silver grey hair color, microphthalmia with cloudy corneas, mental retardation/spasticity, athetoid movements/growth retardation)
- Infantile systemic hyalinosis (Gingival hypertrophy, thickened skin/focal skin nodularity, joint contractures/osteoporosis, diarrhea/failure to thrive, recurrent infections/death (infancy))
- Jones-Hartsfield syndrome (GF, progressive sensor, neural hearing loss)
- Murray-Puretic-Drescher syndrome (aka juvenile hyaline fibrosis…GF, multiple subcutaneous tumors, sclerodermiform atrophy, osteolytic and osteoclastic skeletal lesions, recurrent suppurative infections, painful flexural joint contractures, osteolysis of terminal phalanges, stunted growth/early death)
- Ramon syndrome (GF, cherubism (or multiple giant cell lesions), seizures, mental deficiency, hypertrichosis, stunted growth, juvenile rheumatoid arthritis)
- Rutherford syndrome aka oculodental syndrome (Gingival hypertrophy, corneal opacity, mental retardation, failure of tooth eruption, aggressive behavior)
- Zimmerman-Laband syndrome (GF–hypertrophy, absence/dysplasia of the terminal phalanxes or nails of the hands or feet and thick lips, bulbous soft nose, thick floppy ears, mental retardation, hepatosplenomegaly, hypertrichosis, hyperextensibility of the joints, ocular symptoms)
Periodontitis was believed to be associated with plaque, now what is the presumed etiology?
microbial-shift
What is the microbial shift that occurs in periodonitits? What are some of the bugs to blame?
gram pos to gram neg (anerobic)
- Treponema denticola
- Tannerella forsythensis
- Porphyromonas gingivalis
- Aggregatibacter actinomycetemcomitans
- Prevotella intermedia
- Campylobacter rectus
- Fusobacterium nucleatum
Controversial but, what are 2 viruses that have been implicated in the development of periodontitis?
CMV, HSV
What % of periodontitis cases are hereditary? (host response to the pathogens)
50%
What are some systemic disorders associated with periodontitis? (there are 21 lol)
- Acatalasia
- Acrodynia
- AIDS
- Blood dyscrasias (Leukemia, agranulocytosis, cyclic neutropenia)
- Chediak-Higashi syndrome
- Cohen syndrome
- Crohn disease
- DM
- Dyskeratosis congenita
- Ehlers-Danlos syndrome, IV and VIII
- Glycogen storage disease
- Hiam-Munk syndrome
- Hemochromatosis
- Hypophosphatasia
- Kindler syndrome
- Langerhans cell disease
- Leukocyte dysfxns w extraoral infections
- Oxalosis
- Papillon-Lefevre syndrome
- Sarcoidosis
- Trisomy 21
NUP is caused by spirochetes and what type of bacteria?
Prevotella intermedia
What is the etiology of aggressive periodontits?
- specific bacterial flora AND 2.the presence of a selective immune dysfunction
Age for localized agressive periodontitis? What 2 areas are most commonly affected? What bacteria is to blame?
11-13 years…1st molars and incisors (erupted the longest).. AA (A. actinomycetemcomitans) 90% of cases
What antibiotic combination works best against A. actinomycetemcomitans in aggressive periodontitis?
amoxicillin and metronidazole
Pattern of inheritance for Papillon-Lefevre? Gene mutation? Chromosome?
AR…cathepsin C gene on ch 11
What is the closely related syndrome to Papillon-Lefevre syndrome? What is the difference?
Hiam-Munk syndrome…skin more severe, perio less severe
What are the 4 signs of Papillon-Lefevre syndrome?
- palmoplantar keratosis
- progressive periodontal disease
- recurrent skin infections
- several skeletal malformations (calcification of falx ceribri and choroid plexus)
Papillon-Lefevre: age at manifestations?
first 3 years of life
What is the radiographic appearance of Papillon-Lefevre patients?
“teeth floating in soft tissue”
What bacteria has been related to the periodontitis in Papillon-Lefevre pts?
A. actinomycetemcomitans
How are the skin lesions of Papillon-Lefevre typically treated?
retinoids (isotretinoin = accutaine)
